Trauma Scoring Systems

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Multiple trauma scoring systems have been promulgated over the years. These scores were developed for trauma triage and others used to evaluate and predict outcomes:

Revised Trauma Score (1989) uses the initial respiratory rate, systolic blood pressure and GCS of the patient. The score has good inter-rater reliability. The higher the score the higher the probability of survival. The scores range from 0-7.8. 

Injury Severity Score (1974) is based on an abbreviated injury score (AIS). Each injury is assigned an AIS score, ranging from 1 (minor) to 6 (lethal). The highest AIS within each of six body regions- head/neck, face, thorax, abdominal/pelvic contents, extremities, external structures- are identified. The ISS = the sum of the square of the three highest of these scores. Scores range from 0-75; any AIS of 6 automatically results in ISS= 75. It does not consider age of physiologic status, and may misrepresent injury severity when injuries are confined to a single body region (e.g. in penetrating trauma). Below is an example of an ISS calculation:

ISS Body Region	Injury	AIS Code	Highest AIS	AIS2
Head Neck:	Cerebral contusion ICA: complete transection	140604.3 320212.4 210600.1	4 1	16
Face:	Ear laceration	450220.2	2
Chest:	Rib fractures Left side, ribs 3-4	543800.3	3	9
Abdominal:	Retroperitoneal hematoma	851800.3 910200.1	3 1	9
Extremities:	Fractured femur
External:	Overall abrasions			ISS=34

NISS (New Injury Severity Score) considers the three highest AIS scores, irrespective of body region. This improves its predictive power for penetrating injury.

The TRISS method is logistic regression equation based on the Revised Trauma Score, ISS and age. It allows for the difference between blunt and penetrating injury.

The ASCOT- a severity and characterization of trauma score- is very similar to the TRISS method in that is uses the components of the Revised Trauma Score but in a separated manner of Glasgow Coma Scale, systolic blood pressure and respiratory rate and also uses a different scoring system for injury to the different body regions, analogous to the ISS, and also includes age. Predicted outcome is also based on logistical regression analysis.

The APACHE II (Acute Physiology and Chronic Health Evaluation) - is a predictor of mortality derived from a logistic equation utilized both acute and chronic conditions. The acute physiology score includes 12 data points: temperature, mean arterial blood pressure, heart rate, respiratory rate, paO2, pH, sodium, potassium, creatinine, hematocrit, white count and Glasgow Coma Score (the acute score ranges from 0-72). The chronic score accounts for respiratory failure (asthma, COPD, aspiration), heart failure (valvular dx, CHF, CAD), liver failure, immunosuppression, age and operative status (elective, emergent, non-operative)

For further details: http://www.trauma.org/archive/scores/           http://www.trauma.org/index.php/main/article/387/

For APACHEII calculation: http://www.sfar.org/scores2/apache22.php

	1 (Minor)	2 (Moderate)	3 (Serious)	4 (Severe)	5 (Critical)	6 (Unsurvivable)
Head/Neck	Superficial Scalp lac	LOC: GCS 15	Cspine fx Lac with blood loss>20% CHI-GCS 9-14 ICA: Intimal flap	DAI with GCS <8 ICA: intimal flap with neurologic deficit	Cord contusions with paraplegia/quadriplegia or neurogenic shock Brain stem- DAI Penetrating injury	Decapitation
Face	Cornea abrasion Mandible fx- subcondylar	Deep tongue lac Zygoma fx T-spine fx	Maxilla fx- Lefort III	Lefort III w/ 20% blood loss
Chest	Chest Wall contusion	Rib fxs Brachial plexus injury	>3 rib fx or hemo/pneumothorax Bronchus perforation Pulmonary contusion	Diaphragm rupture w/ herniation Myocardial contusion with shock	Aorta transection Tension Pneumothorax	Aortic transection-ruptured
Abdomen	Abdominal wall contusion	Spleen-subcapsular hematoma<50%	Iliac artery lac Bladder perforation Colon perforation	Liver- deep lac Parenchymal disruption< 75% of hepatic lobe	Kidney-hilum Avulsion Liver>75% destruction of lobe	Hepatic avulsion
Extremities Pelvis	Skin/SQ/Muscle Laceration	Brachial a-lac Radius fx-closed Scapula fx Degloving injury Brachial plexus injury	Humerus fx Femoral a.-lac Crushed/mangled extremity	Pelvis fx- substantial deformation and displacement	Pelvic fx w/ shock
External	Burn <10% TBSA	High Voltage electrical injury with muscle necrosis	Burn 20-29%-TBSA Inhalation injury	Burns 30-40% TBSA	Burn 40-89% TBSA	Burn- > 90% TBSA